How to File a Grievance/Complaint with Your Health Plan

How to File a Grievance/Complaint with Your Health Plan

Health plans are required by law to have a grievance process in place to resolve enrollee complaints within 30 days. In most circumstances, you are required to file a grievance regarding each issue/request with your health plan and participate in the process for 30 days before submitting a complaint to the DMHC. Exceptions to this requirement include when there is an immediate threat to your health or the request was denied as experimental/investigational. In either of these instances, you may seek immediate assistance from the DMHC.

You can file a complaint with your health plan by phone or by mail. You may also be able to file a complaint on your health plan's website.

You can file a complaint with the Help Center if you are not satisfied with your health plan's decision or if you have not received your health plan's decision within 30 days.

Your health plan membership card has a member services phone number listed on the card. You can call that number if you want to file a complaint (grievance or appeal).

You can also find a health plan’s member services phone numbers and web site here. Type your health plan's name in the box below and click Enter. If you do not know the plan's whole name, type in part of it.